For US Healthcare Professionals

Signs that PsoriaSiblings are making themselves at home under a patient’s skin

Not all patients with plaque psoriasis (PsO) will develop psoriatic arthritis (PsA) or inflammatory bowel disease (IBD), but recognition of specific clinical symptoms beyond plaques on the skin may help inform early diagnosis, specialty collaboration, and more comprehensive care.1-6

Clinical presentation of PsA

  • Joint pain and stiffness in joints, most frequently occurring in the morning, in the fingers, toes, wrists, and lower back5,7

  • Dactylitis, a "sausage-like" swelling of an entire finger or toe6,10

  • Enthesitis, inflammation where tendons and ligaments attach to bone, commonly causing pain in the heel or sole of the foot6,9

  • Changes in the fingernails like pitting, discoloration, or lifting of the nail from the nail bed5,6,8,10,11

Clinical presentation of IBD

MAJOR CRITERIA9:

  • Rectal bleeding, unless symptoms of hemorrhoids

  • Organic, chronic diarrhea (onset more than 4 weeks before)*

  • Perianal disease†

MINOR CRITERIA9:

  • Chronic abdominal pain (onset more than 4 weeks before, persistent or recurring)

  • Iron-deficiency anemia or iron deficiency

  • Extraintestinal manifestations‡

  • Fever or feverishness, no focality, lasting more than a week

  • Unexplained weight loss

  • Family history of IBD

*Organic characteristics: aqueous diarrhea or diarrhea that awakens patient at night, with accompanying symptoms (weight loss, fever or signs of malabsorption), or accompanied by extraintestinal manifestations.

†Perianal disease: set of abnormalities that, alone or in combination, appear in the anal and rectal area of patients with Crohn’s disease. It can be the disease onset form and occur years before the onset of intestinal symptoms. The range of lesions included: fistulas, abscesses, skin folds and perianal maceration (and even ulceration).

‡Extraintestinal manifestations: nodular erythema, gangrenous pyoderma, oral sores, cholangitis.

A quick conversation could make a meaningful difference

Patients with PsO may not always be forthcoming with their symptoms. They may think what they're experiencing isn't relevant to their dermatologist or connected to PsO, so consider asking them a few questions:

  • Are you experiencing any joint pain or stiffness?

  • Are you experiencing any persistent gastrointestinal (GI) issues?

  • Are you experiencing any changes to your nails or swelling in your fingers or toes?

Consider monitoring all patients with PsO, PsA, and IBD for symptoms of each. Early recognition may result in timely diagnosis and appropriate treatment.1-4

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References

  1. Gracey E, Dumas E, Yerushalmi M, Qaiyum Z, Inman RD, Elewaut D. The ties that bind: skin, gut and spondyloarthritis. Curr Opin Rheumatol. 2019;31(1):62-69. doi:10.1097/BOR.0000000000000569
  2. Felix PAO, Sampaio AL, Silva BL, Viana ALP. Early intervention in psoriasis: where do we go from here? Front Med (Lausanne). 2022;9:1027347. doi:10.3389/fmed.2022.1027347
  3. Noor NM, Sousa P, Paul S, Roblin X. Early diagnosis, early stratification, and early intervention to deliver precision medicine in IBD. Inflamm Bowel Dis. 2022;28(8):1254-1264. doi:10.1093/ibd/izab228
  4. Levine JS, Burakoff R. Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2011;7(4):235-241.
  5. Mease PJ, Armstrong AW. Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis. Drugs. 2014;74(4):423-441. doi:10.1007/s40265-014-0191-y
  6. Gottlieb AB, Merola JF. Axial psoriatic arthritis: an update for dermatologists. J Am Acad Dermatol. 2020;84(1):92-101. doi:10.1016/j.jaad.2020.05.089
  7. Hioki T, Komine M, Ohtsuki M. Diagnosis and intervention in early psoriatic arthritis. J Clin Med. 2022;11(7):2051. doi:10.3390/jcm11072051
  8. Rendon A, Schäkel K. Psoriasis pathogenesis and treatment. Int J Mol Sci. 2019;20(6):1475. doi:10.3390/ijms20061475
  9. Sanz Sanz J, Juanola Roura X, Seoane-Mato D, Montoro M, Gomollón F; Grupo de Trabajo del proyecto PIIASER. Screening of inflammatory bowel disease and spondyloarthritis for referring patients between rheumatology and gastroenterology. Criterios de cribado de enfermedad inflamatoria intestinal y espondiloartritis para derivación de pacientes entre reumatología y gastroenterología. Reumatol Clin. 2018;14(2):68-74. doi:10.1016/j.gastrohep.2017.03.012
  10. Gottlieb A, Merola JF. Psoriatic arthritis for dermatologists. J Dermatolog Treat. 2020;31(7):662-679. doi:10.1080/09546634.2019.1605142
  11. Scher JU, Ogdie A, Merola JF, Ritchlin C. Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition. Nat Rev Rheumatol. 2019;15:153–166.